André Picard is a renowned Health Reporter and Columnist at The Globe and The Mail as well as a bestselling author. His most recent book, Neglected No More – The Urgent Need to Improve the Lives of Canada’s Elders in the Wake of a Pandemic, is an astounding piece that exposes how Canada’s long-term care homes failed our elders in providing adequate care and how critical it is to urgently ‘fix things’.

Speaking with Ms. Leslee Thompson, Executive in Residence Rotman School of Management, U of T at a virtual Speaker Series, André Picard emphasizes that at least two thirds of people who succumbed to COVID-19 in Canada lived in long-term care or assisted living facilities. While the situation was already deplorable in institutional care settings, it took a pandemic to finally take the lid off an already brewing national crisis.  

We Failed Our Elders!

André Picard asserts that elder home care is the most viable solution to our long-term care crisis and had it been effectively in place, it could have mitigated the impacts of the COVID-19 on this vulnerable group. However, in absence of adequate home care and our ageist mindset, a vast majority of our elders unwillingly ended up in institutional care, allowing the pandemic to wreak havoc. Below, we explore some of the reasons for the low take-up of home care that pushes our elders and their caretakers towards institutional care. 

Ageist mind-set:

The renowned author argues that at the bottom of this national dilemma is our ingrained philosophy of ageism which translates in our public policies. If this were not the case, we would not be priding ourselves in building 600 bed prison-like institutional care homes for our elders. As soon as our elders reach a certain age, the first instinct is to place them in long-term care rather than looking into opportunities of delaying this as much as possible through adequate home care. 

Unavailability of adequate home care:

While he hails home care as the most fitting alternative to nursing home and long-term care settings, he does emphasize the lags in the system. In most cases, home care is not readily available for chronic illnesses such as dementia. And in cases where it is being provided, it is inadequate, at less than 3hrs per day.

Undervalued Personal Support Workers (PSW):

Mr. Picard recognizes that while PSWs are essential for elder care, they are immensely undervalued in terms of lower pay and higher workload with more patients to manage. Therefore, it comes as no surprise that most people are not keen to take up this work and is thus, mostly left to immigrants and refugees, increasing worker turnover. Consequently, all these factors assimilate to diminish the quality and quantity of care received by each elder, forging the way to institutional care.

Untrained and burned-out caretakers:

On average 80% of all elder care is being undertaken by unpaid caregivers such as spouses, children, and grandchildren. While most people lovingly take on this role, there are certainly physical limitations involved. Firstly, this caregiver group lacks basic training in adequately caring for an elder, especially one suffering from chronic illnesses. Secondly, most of the caretakers are exhausted from providing care round the clock and suffer burn-out. Ideally, there should be some relief in terms of PSWs, however that is not the case. Therefore, faced with inadequate training and fatigue, caregivers, though unwillingly, end up opting for institutional care for their loved ones.

What needs to Change?

There is no denying that the system requires major overhaul. And in the wake of the pandemic, there is no better time to finally address the issues we have all chosen to ignore for far too long. In his book, André Picard details some areas for reform, discussed briefly below:

Staffing:

Ensure that Personal Support Workers (PSW) can provide at least 4 hrs of hands-on care. This can only be done by increasing the capacity of PSWs and paying them appropriately. 

Infrastructure: 

Instead of building large, prison-like long term care homes with 200 to 600 beds, integrate elders into the community. The Nordic countries such Denmark should be employed as benchmarks to assimilate rather than shun away elders.

Choice: 

Currently, in Canada the government on average spends $180/day for each elder in a nursing home. If caregivers and elders can choose where they spend this care allowance, Mr. Picard asserts that 25% of people will immediately come out of institutional care.

Advocacy: 

The failings of this system impact a vulnerable group, most likely suffering from chronic illnesses, such dementia. Therefore, they cannot advocate for their rights on their own. Their caregivers might also fail to do so, since they suffer from burn-out. Thus, it is our communal responsibility to band together and advocate for the rights of all elders to live with integrity till the end of life. 

Involvement of elders: 

It is high time we let elders and families make decisions for themselves, rather than being pushed to take actions they are not keen on. One way of doing so is by giving power back to patient/family councils and not just keep them for show. Again, it is important to look at our industrialized counterparts in Europe, where patient associations are as powerful as the medical associations, emphasizing the importance of having all stakeholders on board.

Role of the Private sector: 

André Picard emphasizes that while there are some ‘bad apples’ in long-term care, we cannot generalize them to the entire private sector. However, there is an immense need to regulate the sector. And by regulation, he does not imply more rules and laws but rather focuses on simplifying regulations, with a prime focus on patient satisfaction. 

Accountability:

Presently, long term care falls under five different ministries in Ontario, making it impossible to navigate the system. Mr. Picard believes that there should be a separate ministry for elder care, ensuring that elders and their caretakers know exactly where to turn to with their concerns. 

How Can We Make a Difference?

We at LocateMotion Inc. have developed SenSights.AI, an easy-to-use mental health & well-being intelligence platform for elders & caregivers. It aims to help older adults ‘age in place’ by tracking the progress of early cognitive decline by capturing vitals, daily notes, medication effects, feelings, behavior, and finally assessing virtual interventions based on risk-levels. 

Offering 24/7 remote monitoring, personal emergency interventions, access to physicians and data collection, increases patient and caregiver engagement and knowledge about mental health (especially during the decline stage) and related modifiable factors, improving healthy living behaviors and potentially delaying dementia progression in high-risk populations. 

Additionally, SenSights.AI offers telehealth services that help at-risk providers, home health, skilled nursing, long term entities increase their capacity by complimenting virtual care with a physical visit, reduce readmission rates and avoid wandering and fall episodes by offering proactive monitoring and risk profiles along with smart alerts.

Our holistic approach to continuous patient monitoring, caretaker engagement and building capacity of personal care workers will ensure that home care becomes the most convenient option for you and your loved older ones. Together, we can envision a future where as André Picard hopes each elder has a place, not in institutional care but rather in the safety and comfort of their own home and community!

Book a demo today to learn more about LocateMotion (SenSights.ai) and how our proactive monitoring solutions can work for you at Sensights.ai/demo

Follow us on LinkedIn at @LocateMotion for more updates. 

Contributors: Nauman Jaffar & Mariam Javed.